NHS will 'sleepwalk' into more Staffords without radical change

The NHS will “sleepwalk” into a succession of major scandals on the scale of
Mid Staffs without radical action, including a mass programme of hospital
closures, the outgoing head of the health service has said.

Sir David Nicholson said the need for action was “very urgent” and that without it, the safety of patients would be compromisedPhoto: PA

Officials said the NHS will be overwhelmed by the demands placed on it without unless fundamental changes are made within five years to centralise hospitals, create major GP centres and close a £30 billion funding gap.

Sir David Nicholson, NHS England chief executive, who is due to retire by next year, said the need for action was “very urgent” and that without it, the safety of patients would be compromised, with more failings on the scale of those at Stafford Hospital, where up to 1,200 people died.

Without such changes the fundamental principles of the NHS, providing care which is “free at the point of use,” might not survive, he said.

Today the organisation which holds the NHS budget has published a report which states that services threaten to soon be overwhelmed by the pressures on them.

Later this year it will publish detailed plans setting out how hospitals will be centralised, with more specialist services in larger “centres of excellence” amid sweeping changes across the country.

Sir David refused to be drawn on how many local district general hospitals might close, saying specific plans would be drawn up by local health officials, but said the “end point of this is the concentration and centralisation of a number of services” across the country.

He said that in at least half of the country, treatment of stroke sufferers needed to be re-organised into fewer centres, as has happened in London, where units provide access to brain scans, cardiologists, labs and urgent treatment.

Treatment for vascular surgery, cancer, and a wide range of surgery was also better done in larger units where surgeons carry out high volumes of operations, officials said.

Family doctors will be instructed to work in larger group practices in many parts of the country, offering a wider range of services, under a new GP contract under negotiation.

Sir David said the days of the “cornershop” model of GP practices was over, and small surgeries would be replaced by large centres who could offer more to their patients.

Officials said that without such radical changes the NHS will fail to cope with the pressures on it, fuelled by ageing population and a sharp increase in the number of people suffering from long-term conditions like diabetes and heart disease.

The chief executive said all developed countries were stuggling to cope with the demands on them.

Some, like Ireland, have made drastic cuts to costs, especially in pay to staff, he said.

Others, like Greece and Spain have reduced the amount of free healthcare available, so that more people have to pay for their care, while Germany and the Netherlands have increased funding.

Given the likelihood that the NHS will not receive such increases from Government, with spending tracking inflation, Sir David said that changing the model of care was the best way to protect the service, and retain the NHS’s fundamental principles.

He said that meant that changing the model of care was the best way to protect the service and he was “really worried” that if the NHS attempted to “muddle through” as it was there there would was likely to be more scandals like that at Stafford.

“That is exactly the position,” Sir David stressed. “That is my point about not muddling through and sleepwalking into this”.

Sir David recently announced his intention to retire by next March, after months of sustained criticism for his part in the scandal, as chief executive of the local health authority as standards at the hospital deteriorated.

Decisions on future changes should start to be made by the end of this year, he said, but said the public needed to be part of the debate.

“I think it is really really urgent that we take the decisions,” he said, after which changes should be made “rapidly”.

Plans to make changes to health services and close major units have been ferociously opposed in the past, with MPs of all parties lobbying against closures of Accident & Emergency, maternity and cardiac units.

In 2001, recommendations were made to have fewer centres performing children’s heart surgery but the plans have been blocked by a bitter legal dispute, and the changes have yet to be made.

Despite the scandal at Stafford Hospital, campaign groups are battling to maintain services there which are now threatened with closure.

A Department of Health spokesman said: “The NHS has always had to respond to patients’ changing needs and expectations. As lifestyles, society, technology and medicine continue to change, the NHS needs to change also. However, NHS England are clear that this will not mean cutting, charging for or privatising services. And this does not change the fact that any changes to local services must have the support of GP commissioners, be backed by clear clinical evidence, involve local people and support patient choice."